East African Community (EAC) Rorschach Performance Assessment System (RPAS): Training & Feasibility Study

Sara Snyder, PsyD, MPH, MA

Cambridge Health Alliance – Fellow
Snyder_Sara poster

Scientific Abstract

Background: Since the 2007 inception of the global mental health field, we have seen the utility of capacity-building care models coupled with locally-adapted Likert-scale measures of psychosocial functioning; however, we have seen minimal progress in psychometrics. We propose this is related to the dominance of Western, educated, industrialized, rich, and democratic (WEIRD) psychological assessments and norms. To address this gap, we trained local providers to gather RPAS feasibility data across three East African Countries: Rwanda, Tanzania, and Uganda.

Method: We used a 16×5 Lot Quality Assurance Sampling design (5 people/cluster, 16 clusters/country). Providers were trained to RPAS administration and coding proficiency standards (or R-Optimized). Secondary measures assessed participant well-being and construct validity for select RPAS variables. Measures included: Self Report Questionnaire 20 (SRQ-20), Hopkins Symptom Checklist 25, CAGE Substance Screener, Harvard Trauma Questionnaire, and Ishihara Color Test. Reliability checks were conducted on 30% of collected data. Between-groups contrasts, effect sizes, and linear regressions were run in RStudio.

Results: Of the 66 EAC providers, 21 (31.82%) were trained to R-Optimized proficiency. Our participant sample (N = 235) age and education ranged from 16-78 and 0-18; respectively. The majority of participants were female (55.8%), married (52.4%), Christian (59.7%), and urban-based (44.8%). Comparing EAC data to R-Optimized modeled normative data, we found differences among 25 of 31 (80.64%) evidenced-based variables and 16 of 22 (72.73%) evidence-emerging variables. Significant regression results demonstrated construct validity for three evidenced-based variables a: measure of thinking disturbance/severity correlated with SRQ-20 (p = .017); and measures of ‘gut-based’ and ‘internal-based’ coping styles correlated with Ishihara Color Deficiency Test (p = .001, p = .046; respectively).

Conclusions: This was the first study to evaluate RPAS norms in Africa. Our research indicates two key RPAS needs: norms to represent non-WEIRD persons and a colorblindness screener to avoid over-pathologizing coping ability.


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research Areas


Sara A Snyder, PsyD, MPH, MA, Rugema Lawrence, PhD, Lynda Nakalawa, Msc, MPhil, Samuel L Likindikoki, MD, Hana T Hamdi, MPH, Marc J Diener, PhD, Danielle Knafo, PhD

Principal Investigator

Sara A. Snyder, PsyD, MPH, MA

Affiliated Website